Peter Gordon, a retired psychiatrist from Bridge of Allan, Scotland, never imagined he would find himself on the other side of the system he once worked within. Prescribed psych drugs for stress and insomnia, Peter initially trusted the safety and efficacy of these treatments. However, as withdrawal symptoms emerged—crippling anxiety, cognitive impairment, and a profound sense of detachment—he realized how little his medical training had prepared him for the reality of psych drug dependence. In this episode, Peter shares the irony of his journey, the shocking gaps in medical education regarding withdrawal, and his personal fight to reclaim his health. Listeners will gain insight into how even trained professionals are left in the dark about the risks of the very drugs they prescribe.

You can find out more about Peter Gordon through his personal website: https://holeousia.com

Transcript (AI generated)

00:00:00    many people will take antipressants and not have problems stopping them but what are the chances for those people who take antipressants and find that they can't stop them what is the chance of them being believed my temperament changed i fell out with the neighbors i did erratic things like throw things in the garden and stuff like that i was blaming my wife for things that she hadn't done i mean i wasn't delusional but i was i wasn't peter knowing what i do now there was no way i would have personally would have taken an

00:00:24    anti-depressant i'd have thought maybe some other short-term measures to physical measures to support me and relied on the love and support of my friends who i have many and my family hello and welcome um this is ici stories uh and i'm cooper davis here at intercompass initiative i am here joined today with peter gordon um why don't you give us a little bit of your kind of current who you are today and then we'll we'll jump back and figure out how we got here i retired four years ago i worked as an nhs psychiatrist in

00:01:11    scotland for over 25 years um i retired at the age of 52 so i've retired early and i have my own experience of um long and protracted experience of uh taking a prescribed anti-depressant which i was initially prescribed for anxiety a long long time ago i don't i am so happy to be called a retired doctor but these days i'm a gardener nhs just as a quick reminder is the national health service which is what in the united states um people would describe as socialized medicine um more or less although people who actually

00:01:53    receive nhs services might quibble with that definition um uh but essentially the that's the there's there's a slightly different set of incentives and dynamics with uh medical care in general and psychiatry in particular in um the uk because of the role of the nhs and the amount of taxpayer money that goes into it and it's you know what it the responsibility that the nhs has been charged with um so just that's a little note we can't as much as we might like to we can't map the us experience of

00:02:36    psychiatry as a practice onto the uk experience exactly i think that's right and and so and so i guess getting into that initial um that initial that you starting treatment on that ssri for anxiety do you want to talk a little bit about uh what what were you calling that before you thought of it as anxiety i think people outside me would say and would confirm this i'm quite sensitive i'm quite gentle um i'm i i've got a good sense of humor but i can be quite serious too um quite principled but i

00:03:14    was as a young man i was really quite most most people will identify with this i think i was quite sensitive i was quite shy um i wasn't bold i wasn't an extrovert um and i had my family backdrop was difficult my childhood was difficult without any major traumas but it was difficult and i'm not going to go into that here so that was so i married shan my my life was going well and then um our first baby was uh was born and there was nothing to do with our first baby andrew who's now a grown man but um

00:03:44    he didn't he his infant feeding was very difficult so nights were extremely disturbed for both of us and at the same time as this um i was training in psychiatry and doing my membership exams which are quite a lot of work so i was i was stressed and i was sleepd deprived so i went to my local doctor the gp and she said oh well there's this new medicine that's just been licensed for social anxiety um and i think you should try it and being in being in psychiatry myself i was then receiving training like this

00:04:17    which was a it was i was banging what was called um i don't think you had it in america but in the uk it was called the defeat depression campaign and it was a five-year campaign from 1993 to 1998 that was sponsored primarily not only by but primarily by the pharmaceutical industry and the royal the royal colleges in the uk the general practition practitioners college and the psychiatrist college backed this campaign and this campaign was to uh educate educate both uh potential patients the public and doctors alike

00:04:52    that there's no shame in taking an anti-depressant that they can be used for other things other than just depression such as anxiety menstrual problems etc etc so it was a very widely based campaign so i was this is part of my training so i thought what can the harm be for me trying an anti-depressant for my sleep and anxiety and i'm going to stop there but um 30 years on i wish i'd known different the which ssri was it that that you started on yeah they might i think it's different names in the usa but um it's probably

00:05:28    paxel with you um it's the the chemical name is proxitine in the uk it's called thoroxat and um the the the advert for for throughout the period of the defeat depression campaign afterwards which has always struck me as with great irony the advert that the pharmaceutical company used was says this drug has a powerful embrace they were see the powerful embrace is a positive thing because it makes you better uh but by by god this drug has had a powerful embrace in me though i'm smiling and happy just now um

00:06:00    i i i've learned to live with this drug and and its many consequences and maybe come to later at at some points where it's really been awful but over over these 30 years that i've been on this drug i've tried many a number of times and particularly i was one of the first really to try and get off this drug um in scotland realizing that i had a a problem with dependence on it and withdrawal symptoms but just to to let you know i'm still taking this drug now and i've decided to still take it and people can argue whether this is right

00:06:33    or wrong i've heard some people say peter you lack balls because you've not come off this drug i don't want this drug it's it's it's affecting my life and i'm living with it it's i'm getting older now but the all the side effects the small side effects that they say they're catching up with me one thing that we feel strongly about here at intercompass initiative uh as an organization and you know our team and it bears repeating here that there is often a presumption that um you know that that that sort of our

00:07:07    goal we've been accused of being anti-drug uh we are not anti-drug we are we are pro-informed consent and so what you describe peter um is an incredibly common experience where you are now being able to make a fully informed choice maybe in the past you were not but now you have access to all the information you know the cost and benefit of staying on it you know the cost and benefit of trying to struggle to come off of it um you know what it does and does not do and so uh as far as the organization that is hosting this

00:07:54    conversation is concerned that's where we want people to get to ideally it happens earlier right ideally it happens before that first meeting i think the slightly different thing for me though i'm not alone is that not only was have i been i've not been a patient for a long time though i'm on a prescribed medication but i've been a patient and a psychiatrist and i particularly i i think one thing that's different with me is i've got this longitudinal history to see what has happened in the narrative

00:08:26    particularly by anti-depressants from 30 years ago to today and that narrative is i think one that humankind needs to listen to so that we don't hopefully repeat the mistakes again i'm not anti- psychiatry though i've been cu i'm accused of it all the time all i'm waiting to do is improve people's lives if medications help them that's fine i don't have an issue with this but we need to keep our um we need to keep our ears open our eyes wide otherwise we won't learn is revealing that psychiatrists themselves

00:08:58    in this case very senior uk psychiatrist can be as stigmatizing as anybody else if not worse so i want to make sure i have this right so you you're experiencing as a sensitive man a difficult time in life a disruptive time in life i have a new set of responsibilities the focus of my life has shifted um and so you're entering a sort of different life phase and a different almost like you're you're now have to become a new persona um and you're experiencing that with a lack of what feels what feels really necessary

00:09:45    you need more sleep you need more um to feel more settled you need to feel like your decisions are coming from a place of groundedness the family doctor suggests off label what we call off label prescription cuz it's not it's for depression it's not for anxiety and sleep right it was primarily sleep disturbance and at the same time as studying for professional exams you go with a problem in mind you that problem is offered some definition let's call this a you know anxiety um and let's and then and then here's this solution

00:10:24    that's available to that anxiety is this drug and so i'm wondering if at any point did your conception of your problem shift once you started engaging in psych treatment even if it was through your gp and you weren't you weren't getting psychotherapy or anything or whatever it is that that prescribing psychiatrists do did your sense of what you needed change before that appointment to after yeah it's a really good question cooper and it's it's not entirely straightforward to answer but i think i

00:11:00    showed this book briefly this and you can't see it but if you read along the top it says uh down with gloom how to defeat depression i used to hand this book out to patients because at this time that i was having anxiety i was at the early stages of training in psychiatry so this is the early this is 93 to 98 really and at that stage i was still training in psychiatry and every teaching we were taught about the and the one word one important word was mentioned was often missed out here the chemical imbalance theory and the word

00:11:33    the important word that was missed out or we kind of forgot was theory and so though there's a number of very senior psychiatrists today that say that the chemical imbalance theory was never taught to psychiatry particularly a a professor professor in america called ronald pies what a load of baloney i can't speak for america i can speak i can speak for my training because i was training at the time we talked about the chemical balance inside out and how that relates to me is i thought cuz i that's

00:12:01    what i told my patients you've got a chemical imbalance you shouldn't feel any shame and taking an anti-depressant whether it's for depression or anxiety or some other problem this is fixing a deficiency of a a neurotransmitter released in your brain don't feel any shame by it so that was my mindset when i went to my gp to so i thought there was no harm in this but one of the big key messages it gave to both patients and doctors like myself were that there would be and i could quote i think pretty accurately that we should dispel

00:12:31    the idea that there will be any difficulty in stopping these medications that was the key message sent out and i like all the other people believed that i took it i think i thought that this is a factual thing you know this is evidence-based medicine which we were beginning to learn back then so do no harm um is this driving ethos and so the way dino harm can sometimes be hijacked is you if you say that look whatever harms people are concerned about are less than the harm of not taking treatment

00:13:10    x that's a claim that is very difficult to verify but it has a really high emotional resonance so you see it in all kinds of different places um but with anti-depressants it's it's we the a good doctor an intelligent doctor um or a good guidance counselor or a good social worker or a good psychotherapist or any of the people who we tend to turn to in the system these are people who are often driven by their compassion and care and they want um they want people to be okay and taken care of and so you

00:13:52    have to be careful about telling people the truth because they might die if you do that so there that last part of that is a bit of a jump right there's probably a lot of room between you know um people dying and and people being given like the full picture on what the evidence does and does not show with these treatments i think there's a lot of room in there but for some reason the discourse even today still tends to be uninterested in looking at all the space in between those two points exactly

00:14:33    exactly i'm so passionate about this too i'm so passionate you know it's not as if everything is all good and all bad there's the wide range in between and it doesn't help any of us if the debate becomes totally polarized one way or another and um it's just exactly what you said earlier on cooper this is about being having discussions with a wide range of people so so that um decision-m can be as informed as possible when we're suffering all of us and we're all involved in this are often looking for

00:15:02    quick fixes because we're suffering and but the trouble with this is that if you've got a a simple answer to a complicated thing the implants it can turn out to have some issues and i'll stop there because you're a training you're a psychiatrist in training you already have this you're going into this with an assessment that like yeah my brain is just having a tough time with this for whatever reason there's really no downside to going on this treatment i see a clear like you know the the problem is a lock the pill could very

00:15:35    well very likely to be the key to that lock and i need to sort of get on with my life and so i think what a lot of people find when they look back at their story things change between when when you before you went on the drug and after you went on the drug but it wasn't just the drug that was changing it was the circumstances of your life were changing in profound ways and in hindsight being able to tease out how much of this was the drug how much of this was just like this whole new set of responsibilities that i had right and

00:16:09    so tell me subjectively acute acutely what is your experience when you start to notice a difference what is that like and then sort of in hindsight less acutely but more ambiently what what was your experience i i didn't have a a terrible response to taking seroxa when i first the very first time i started it i didn't know from my memory i didn't notice a big difference in my sleep or my anxiety and i've asked my wife about this and she she says no uh but i've kept taking it and um so it didn't make a big

00:16:48    difference it didn't make things awful didn't just didn't make a big difference and probably it's hard to know exactly but i would estimate it was maybe about three months into taking this medication i just stopped it because i thought it's not making a big difference nothing and i what what i can remember vividly is what happened when i stopped it i was um i'd been off it probably for about um 36 hours and i was out in the garden and i got this buzzing you know people have heard this before but i got this buzzing

00:17:16    in my ears and it wouldn't go away and then this profound headache and and and i was sweating and i said i came into the kitchen and i said to shan who's a gp who's a gp then i said "do you think this these symptoms i'm having do you think these could be related to the fact that i'm i've stopped taking my serox?" and she said "no i don't think so." no i don't think so i think it's something else anyway so i went i took i i took i took the serox again didn't think much more of it and then a few weeks later a

00:17:44    few months later i can't remember exactly i tried to stop it again and i had it exactly the same and it was at that stage there was a a light bulb moment i thought there is something with this drug but i stopped it and i've not had it for at least 36 40 hours i get these symptoms and i don't know what they are so i what i went to that stage is because i i had a good relationship with my colleagues i was training in psychiatry and i went to a consultant psychiatrist who i still keep in touch with he's he's a lovely guy uh brilliant

00:18:11    doctor absolutely brilliant doctor i said to him "oh when i stop these drugs i feel really bad i get these symptoms you think it could be related to my the anti-depressant i'm taking seroxa." oh no no no no no no there's no evidence of that um peter i don't think that's the case and then that started a pattern from then on that i realized and even most of just about all my colleagues in psychiatry were lovely people well-intentioned but when i mentioned this subject and i said "look i think there's more." in my case i said i'm not

00:18:40    saying this may be true for all people but in my case i don't be seem to be able to stop this drug without feeling hellish both physically and mentally i got i got much more anxious than i'd been when i first presented my symptoms and they said "no no no no no no peter this is you." you know they said it nice language but they said "this is you this is relapse." and i would say to them "how could i have relapsed to this?" because these weren't the symptoms when i had when i first took the this uh

00:19:06    anti-depressant i said these symptoms are far worse and i said they go away when i put when i take the medication again but my universal experience was that good and kind people didn't believe me and the narrative that they were following as i had done was that this safe and effective that these drugs do not cause withdrawal problems they're not you don't become you can't become dependent on them they're not difficult to stop i guess what i want to get across you is as a psychiatrist i felt so effing isolated and i i felt

00:19:38    unbelieved i thought well i was unbelieved but if i felt that what are the chances for those people many people will take antipressants and not have problems stopping them but what are the chances for those people who take antipressants and find that they can't stop them what is the chance of them being believed it was a very learn early learning signal about the how stigma it's not so simple the fact you're a psychiatrist that you are combating stigma or that you have some differential better approach to it it's

00:20:06    it's all about narrative it's about whose narrative is prevails and but i think what we all have to do all of us is believe do our best to believe other people's experiences and try and collect them to work out what's the best picture to help people be informed about medications because you can't rely on six to 12 week studies based by the pharmaceutical industry which i don't hate they're just doing the job but you cannot rely on those studies to inform widely based uh prescribing um beyond that period of time did your assessment

00:20:39    of what the drug was doing for you or doing to you um how did that change and solidify over time and was there ultimately a kind of crescendo or um you know was there a a boiling point that was reached so we're talking about here 1993 and i was 26 years old newly married uh uh man u my wife and i had our son and was successful birth and i continued my soroxat through 94 probably through 93 into 94 but i noticed i was getting side effects and these you know there major things there were things like um i

00:21:21    couldn't urinate so well i i found it was harder to pee i sweated a lot and i still do sweat a lot and that's it's the side of it that can be very embarrassing when you're sweating buckets um and i noticed that when i w you know this was directly a direct association with the anti-depressant there was no doubt about it i didn't have these things before and i also a more difficult subject had difficult sexual problems delayed ejaculation basically um and it was a young man you know i'm old now um and

00:21:49    these symptoms some of these symptoms have got worse and um um because the i'm not going to get technical but the anticolinergic properties of anti-depressants they can often cause symptoms like this so those symptoms were sufficient for me to think i don't want to be on the drug longer than i need to be so i tried stopping it and as you've heard i couldn't stop it straight away without these side effects so i said to shan what can i do and she said oh i'll get you a pill cutter you got to remember this is probably a long

00:22:15    time before people were really talking about withdrawal and anti-depressants and none of my colleagues would have agreed with me so i didn't tell any of them just shan so i cut my pills in half and then every quarter and i tried that i still got the withdrawal symptoms and i felt i felt really crap both physically i felt like flu i had this pain in my head these buzzings i woke up at night with rap with dither dreams rapid waking i felt off on and was still trying to do my work at the same time so

00:22:41    shan said i tell you what she says "i think you could probably get a liquid preparation." says "i to my best of knowledge this is way before anybody else in scotland had that tried this." and she says "i'll get you a micro pipet and you can reduce it very gradually." i tried doing that and i did it i can't remember exactly cuz this is a long time ago but i probably tried it over 3 months and i still felt hellish so i just went back to the higher dos then i said i gave it a few months i said "my

00:23:06    i'm going to really try this time but i'm going to do it much slower." said there's nobody i can go to for advice you know the internet was hardly available then well it wasn't um i said i'm just going to do it my own way i'm not going to tell anybody about it but i'm going to reduce it as gradually as i can by liquid preparation this micro pipet and i did that gradual reduction over a year at least a year then probably with within a couple of weeks of get finally getting off the last smallest amount um i started this i i

00:23:35    was i became different i became restless i became my nature is i'm quite sensitive but i was i became irritable i my temperament changed i fell out with the neighbors i did erratic things like throw things in the garden and stuff like that i was blaming my wife for things that she hadn't done i mean i wasn't delusional but i was i wasn't peter so i thought that was the mental side and i felt agitated restless i wasn't sleeping i was sweaty and then i then i then i realized my mood was going low which had never happened to me

00:24:06    before i may be anxious but and i may be sort of bit of a negative thinker but i'd never had to severe depression before but i became really quite morbid and i thought particular my morbid thinking was i was doing harm to my children my we my we children and it was very distressing and so to cut a long story short then that's in 2005 i had a horrible year and um i can tell you about that if you're interested it's i always find this bit the hardest bit of my story to share if you want to if you want to go there i

00:24:40    i we we at inner compass and i personally am a connoisseur of people's most horrible years um i think if you're if you're willing to share uh with this audience uh we would love to hear it and uh i think in general everybody needs to talk more often about their darkest days um probably right it's i'm quite happy to sh i've shared this before as maybe i have had other interviews and that though i don't find it easier it's just easier with time passing and also my children are now successful young adults themselves

00:25:26    they're aware of this story and fortunately i i like to think although i still feel bad about this i i've always worried about how much of my my story with soxat has affected them but i don't think it has affected them too much um they were they were quite we children at the time you know in 2005 my son was 78 and my daughter um four or five um so they don't remember too much but they will remember some and that's that will just be a constant regret i was admitted to a psychiatric hospital in early 2005

00:25:55    a private hospital because of my suicidality um and while i was there um i was really driven i was very distressed and never had this before it was um i don't want to use hyperbole but it was way more severe way more severe than my presenting symptoms for seroxat and i have no there's no family history of major mental illness but there was no no answer to this i was given antiscychotics as well as my anti-depressants antisycchotics were supposed to augment the anti-depressants as i they could the the the diagnosis i

00:26:27    was i presume i was given was treatment resistant depression um and it just all got so bad and at one point i made a a very real effort to end my life and had a curtain steel curtain rail not broken in the hospital i wouldn't be here today and uh i'm just i'm not going to say much more than this but then after that i was admitted i i i discharged myself from hospital i went to my sister and she took me to another to another hospital an nhs hospital in fact the one that i went on to work in um where i

00:26:58    remained for about 3 months and i agreed to take ect treatment electric convulsive treatment um because nothing else was working um so i had a course of ect i think eight treatments for me i i i don't want to get into the ect debate i still have prescribed ect and i have given ect to patients my view is it should be it shouldn't be banned but i'm just going to keep this very simple it shouldn't be banned but it needs to be an absolute last resort um i've got to use my words carefully because ect has saved people's

00:27:30    lives i am aware of that even though it's but it just it was just like knocked me out i didn't think and i you know my wife would come in the next day in but i've still got my diary from the town and she said "i'm going to give you a diary peter because you don't remember one thing you say after another." from the period that i got ect for for a period of probably 12 months afterwards i don't remember my children from that period of time and that's makes me feel sad it's a very strange experience you

00:27:57    look at these photographs and i just of my children my beautiful children and i don't remember it at all so any the reason i'm laboring on that is to say look my experience of soxip withdrawal has been significant life changing this may not happen to everybody and it doesn't i've seen many people able to get off anti-depressant some people can stop them no problem at all but there's a significant number of people like myself who can't and time is now showing there was about one in 40 or one in 50

00:28:24    people taking an anti-depressant then the defeat depression campaign and it gradually went up so we had one in 20 and when i started campaigning it was about one in went to one in 10 one in 8 one in one in nine one in eight one in seven one in five and it's now one in four you've got to ask the question why are so many people taking anti-depressants and it's one of the reasons for this is that they are actually for a significant number of people very difficult to stop and cause great distress and my last thing i'm

00:28:53    going to say in this is that what the psychiatric profession have said in response to this is that all these people the kind of argument is that all these people this is relapse of their illness it's not withdrawal i would question how much professionals are mistaking withdrawal as relapse i mean it would be absurd i would say in fact we've never known it for say one in four of the population to have major to have major depressive disorder that relapses and that they need treatment for that even a percentage of that it would be

00:29:22    absurd that's overmedicalization juggernaut overmedicalization and it's not helping anybody antipressants in my view have a role but will massly prescribe for long periods of time no and i think they have significantly more harms than the safe and effective of mantra that we were all educated to prescribe them what i am interested in though is who is incentivized to know more right who who who is who is incentivized and to what degree to seek out that information of how much of this is withdrawal and how much of this is is

00:30:04    relapse because i know who's incentivized to uh avoid a deep inquiry into that question lots of entities are um and i don't think those entities are necessarily nefarious or good or bad or whatever so i don't think that there's some evil pharmaceutical cabal or anything like that and i i i i know you don't see it that black and white either but i do think a lot about incentives in that you know if you if you if you're an academic psychiatrist or scientist or researcher and your career has been based on this it's only understandable

00:30:42    that you're going to be defensive i don't see these people as bad people i don't i just think that that we all all of us are vulnerable to biases and particularly when you're motivated in an area and um so academia is a big part of this certainly in the uk the uk academic psychiatrists in this area i wouldn't generalize it to all of them but i would say the ones involved in anti-depressants who' had a career in this area come across and indeed the royal college of psychiatrists increasingly are coming across as

00:31:12    defensive and i don't think it's because they're bad my experience with psychiatry psychiatrists were generally good people well motivated i think there's a lot to lose here um there's all there's the reputational loss as well trust in the profession imagine you peter today are are suddenly you're a pharmaceutical executive okay would you um you you you you you're in a boardroom with other pharmaceutical executives and they're saying "guys guess what i think we need to um come up with some ideas for the

00:31:49    scottish government on how they're going to uh use the apparatus of government to help us sell more anti-depressants we're thinking defeat depression might be a good um tagline." okay you're you're there and your job with all of your experiences that you've had so far um your job is to respond to you know peter what do you think defeat depression how do you like that as a tagline what would your response be in that position um it's a good question uh if if if you're if you're if you're in a business and you want to be your

00:32:27    business successful what do you do you want to have a simple message you want to brand it you want to associate it with a very easy phrase such as powerful embrace or safe and effective whereas the safe and effective is probably true based on the evidence but the evidence is only 6 weeks so you just don't tell people that actually this evidence is only 6 weeks and actually most of that evidence you're never going to be able to see because it's hidden in the bottom drawer and so we so as an executive

00:32:55    let's just keep let's just tell the positive messages don't tell the negative messages and as for all the in between which is life let's cut that out let's simple message let's go let's go for this market this is a market business to get our business booming we need to market our drug um and what i would say in my position as peter a faulty um older man now um uh stick as human beings all of us whether we're chief executives uh prime ministers senior civil servants we need to stick to our values human values and that may sound

00:33:31    very twe but it's true values matter values are far more important than money but money is what makes the world go round and we can't live in a naive world where we think we can completely separate from money because that's just never going to happen but if we stick to our values of still being doing our business then i think we'll do a better job and i think scientists there's one other word that needs to come in here is humility m because what's often come along with this evidence-based i i passiately support evidence-based

00:34:02    medicine i i would say it's better to be evidence informed medicine because evidence-based suggests that you you based it in a very wide range but in fact as we've seen with anti-depressants and other medications statins and all things actually the the base was very narrow before it became prescribed in a mass way i'm passionate about evidence but we need to still have some philosophy because evidence there there's so many aspects that are wider than evidence like passing time it's it's very as human beings just

00:34:33    to say "oh yes that's evidence." but it's it's finite for a short period of time to a small number of people so we need to listen to each other we need to respect passing time we need to be more humble and show some humility evidence isn't the only answer because if we just go down that route you'll get this great polarization that we're seeing across western world really you know where i'm right you're wrong no no no there's middle ground here we need to learn from each other and and i'll just reflect back that i

00:35:03    think to me what what bothers me about the defeat depression more than anything else is the lack of humility because it's operating from the assumption that this is something that should be defeated right the the the when i work with i work with young men who have been diagnosed adhd who are who are either deciding to try you know getting off the stimulants or or want to be on the stimulants differently or or don't want to go on at all in the first place and you know one framing that that i use is well if you

00:35:39    want to buy into this diagnostic framework that's fine that can be useful so if we're doing that though the goal here isn't to overcome your adhd the goal is to get better at being adhd right the goal with depression is the same the goal is not to defeat it um that's a dubious goal you're right i i i would i very careful not to use words like defeat or or or military metaphors and i try my best anyway we're going to provide some uh links to peter's stuff in our show notes here and um i advise everybody watching this to go check out

00:36:20    his his website which is just a u will spoil you with the riches you will find there and is worthy of taking some time with it so my final question for you is this peter what can psychiatry learn from landscape architecture oh that's a that's a great question i love it thanks keeper for asking that one um well let's start at the big level what we're all trying to seek what we're all looking for at the widest scale is a healing landscape a healing landscape um let nature in let nature in be be let

00:37:00    understand that um you know weeds are just weeds because people have named them weeds they're just actually flowers um i think psychiatry is needed and there's some people that go through some very severe episodes of distress illness whatever you want name you want to give it be wary of the names that we give to disorders but if you're distressed psychiatry is generally a good thing do your best to just as you've described earlier cooper is to to try and learn from the experience of other people who

00:37:31    have maybe been in a similar situation to you and to think maybe there's other ways and be wary of getting involved in interventions of any sort that are based on evidence that is short-term because the short-term evidence might show benefits and harms but it's not evidence for longerterm use and i think we just we all of us we need to be wary of um which nature tells us the healing landscape tells us that cycles of life move on and we can have you know like i did have very bad times you know a

00:38:02    difficult juncture in my life and i probably need i didn't need support if i went back now i think i knowing what i do now there was no way i would have personally would have taken an anti-depressant i'd have thought maybe some other short-term measures to physical measures to support me and relied on the love and support of my friends who i have many and my family so there's a lot to be learned from landscape architecture and indeed the medical humanities not both people people i was generally liked as a doctor

00:38:32    and the people were sad when i retired early including my colleagues of course there was one one or two people i didn't get on with and they didn't go on with me but by and large it was fine but what my universe of experience was is that people would often just my colleagues would say oh that's just peter you know he's he's he's interested in medical humanities he's done he's an artist he's sens sensitive it's all that fluffy stuff um and i would reply to them i said "no i'm just peter i just happen to

00:38:59    have done those things i'm not saying i have all the answers but i said please don't dismiss these fluffy things as not being able to help you in your life and help you through difficult periods of time maybe in addition to to psychiatry or psychiatry could be a small part but psychiatry shouldn't be that for for a healthy well-being in the world we should one in four of us or whatever the figure might be it's a massive number these days shouldn't be dependent on psychiatry we shouldn't have a mental

00:39:27    health label let's try and while we're here on this planet do more good for ourselves and our fellow inhabitants and not just human beings in this world that's beautiful thank you for that peter and um it what strikes me and what i you you what i'm taking away from our conversation today and i hope others have i'm sure they are hearing this as well you've mentioned a couple times this you know this orientation towards the passage of time and i think that as a gardener anyone who has planted a garden or

00:40:06    raised children or just you know you you make some decisions in a moment and then those decisions play out over time and there's some stuff that you can know there's some stuff you can there's some stuff that just is not knowable right there's a there's a there's there's stuff that's not knowable this is where humility comes in but to your last point in the absence of perfect information right the absence of truly being able to know everything about how everything might go whether you're planting a garden or treating a patient

00:40:48    or making your own decisions about what diagnostic framework to to internalize or what drug treatment to to to start with and in the absence of perfect information we must instead rely on something else it's and and if you're dealing with imperfect information i think that the best guide for navigating decisions is something like intuition is something like empathy is something like human experience the best doctors i've ever had are those who you could look at them and say "this some this is somebody

00:41:30    who's gifted this is somebody who in a um preodern world would likely still be a healer of some kind this is somebody who's obviously drawn and has a way of looking at somebody else and and connecting that to their own experience in in useful fortifying ways um there's an art and a science to medicine that's always been recognized the pendulum has certainly swung towards the technician the the technical um uh practice but i i think what you describe and and people are wrong to deride this has fluffy stuff the art of

00:42:20    medicine is indeed the only thing that is actually going to to uh make sure that the balance of treatment is positive that we don't slide into the realm of the treatments being worse than the diseases it is that instinct um you may not know every possible thing about everything but there are certainly people in all fields who are are gifted in a sense of of what might be going on here and you might not be able to break it down and empirically sort of prove those senses but that does not mean we

00:42:59    should diminish it we need to have the humility to look at fluffy doctors such as yourself and say there's something here that we desperately need and even if we can't codify it or measure it or quantify it put it on a chart um that doesn't mean we need to exclude this kind of fluffy thinking from guiding our actions in relation to ourselves or to others so this is uh as one fluffy person to another peter thank you well said well said no this is just i'm just reflecting back what i'm hearing from

00:43:33    you and it's been such a joy talking to you it's just great to have a transatlantic conversation and um and i'll be in touch uh we're going to do round two peter and um enjoy the rest of your weekend [Music]